The recognition of ADHD (Attention Deficit Hyperactivity Disorder) and ASD (Autism Spectrum Disorder) in females, especially adults, has been long overlooked. While much of the diagnostic research surrounding these conditions has focused on males, a growing body of evidence suggests that ADHD and Autism manifest differently in females, often leading to delayed or missed diagnoses. In this blog, we will explore why adult females often receive late diagnoses for ADHD and Autism the impact of these delays, and the importance of neuro-affirming practices in treatment.
ADHD and Autism in Adult Females: The Case for Late Diagnoses
ADHD in Females
ADHD is often seen as a condition that predominantly affects males, with research historically focused on the male population. This leads to diagnostic overshadowing in females, who tend to display symptoms differently. While males may exhibit more outwardly disruptive behaviours, females are more likely to show internalised symptoms, such as inattentiveness, emotional dysregulation, and academic underachievement (1). Studies have found that females with ADHD tend to be more emotionally sensitive, experience higher levels of anxiety and depression, and may be less likely to present hyperactive symptoms, leading to the underdiagnosis of the condition.
One of the key differences is that females often develop coping mechanisms, such as perfectionism, that can mask the symptoms of ADHD, leading to a delay in diagnosis. These internalised symptoms are frequently misinterpreted as anxiety or mood disorders (2). As a result, many adult females with ADHD go undiagnosed for years, only to receive a diagnosis later in life when other life challenges or mental health issues arise.
Autism in Females
Autism like ADHD, is often underdiagnosed in females due to differences in how symptoms manifest. Females with Autism tend to exhibit more subtle social and communicative difficulties than males and often engage in “social masking”—consciously mimicking social behaviours to fit in (3). This is particularly true for females who may not exhibit the more overt repetitive behaviours associated with Autism in males.
Research has shown that women with Autism are more likely to develop co-occurring psychiatric conditions such as depression, anxiety, and eating disorders, which may further complicate the diagnostic process (4). Additionally, because females are expected to be more socially adept, the social difficulties of women with Autism may not be identified as part of the spectrum, leading to delayed or missed diagnoses.
The Impact of Late Diagnosis in Adult Females
The late diagnosis of ADHD and Autism in adult females can have a profound effect on their mental health and overall well-being. Without a proper diagnosis, many women may struggle with feelings of inadequacy, failure, and confusion about their behaviours and emotions. Some of the common consequences of a late diagnosis include:
- Increased Risk of Anxiety and Depression: As women with undiagnosed ADHD or Autism attempt to meet societal expectations, they may experience chronic stress and internalised self-criticism, leading to higher rates of anxiety and depression (3).
- Self-Esteem and Identity Struggles: Without an understanding of their neurodivergent traits, many women internalise their struggles as personal failings. The discovery of an ADHD or Autism diagnosis later in life can lead to a re-evaluation of their identity, which can be both a relief and a source of stress (5).
- Difficulty in Social and Occupational Settings: Females with ADHD or Autism often face challenges in work and social settings due to difficulties with attention, organisation, or social communication. These settings’ lack of understanding and accommodations can lead to poor work performance, job dissatisfaction, and strained relationships (6).
Neuro-Affirming Practices: Supporting Adult Females with ADHD and Autism
Neuro-affirming practices are essential for supporting neurodivergent individuals, particularly those diagnosed later in life. These practices focus on recognising and respecting the neurological differences of individuals with ADHD and Autism rather than attempting to “normalise” their behaviour. The aim is to provide support that empowers individuals to thrive by leveraging their strengths and addressing their challenges in a way that aligns with their unique neurobiological makeup.
Key elements of neuro-affirming practices for adult females with ADHD and Autism include:
- Strength-Based Approaches
Neuro-affirming care encourages clinicians and caregivers to focus on the strengths of individuals with ADHD and autism. Women with ADHD may exhibit heightened creativity and the ability to think outside the box, while those with Autism might possess extraordinary attention to detail or deep knowledge in specific areas. Emphasising these strengths rather than focusing only on deficits helps to build self-esteem and confidence. - Personalised Support and Strategies
Tailoring interventions to meet the individual needs of adult females with ADHD and Autism is essential. This can involve strategies for improving organisational skills, emotional regulation, time management, and social communication. Cognitive-behavioral therapy (CBT), as well as coaching focused on executive functioning, can help these individuals develop strategies to manage daily challenges effectively (7). - Social Support Networks
Peer support groups and community networks are invaluable for women with ADHD or autism. These groups provide a safe space for individuals to share experiences, strategies, and advice. - Mindfulness and Emotional Regulation
Mindfulness-based practices can help individuals with ADHD and Autism manage stress and improve emotional regulation. Mindfulness interventions have been shown to reduce anxiety and enhance attention and focus in individuals with ADHD (8). These practices encourage individuals to accept their thoughts and emotions without judgment, fostering a sense of self-compassion and resilience. - Advocacy and Education
One of the most important aspects of neuro-affirming practices is educating individuals about their conditions and empowering them to advocate for themselves. By understanding their neurodivergence, women can better navigate work, school, and social environments, ensuring that they receive the accommodations and support they need (6).
Conclusion
The late diagnosis of ADHD and Autism in adult females presents significant challenges, but it also provides an opportunity for growth, understanding, and support. By adopting neuro-affirming practices that focus on strengths, provide tailored support and foster self-compassion, we can help adult women with ADHD and Autism lead fulfilling lives. Through education, advocacy, and empowerment, these individuals can embrace their neurodivergence and thrive in a society that is becoming increasingly aware of the importance of neurodiversity.
References
- Biederman J, Mick E, Faraone SV. Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type. American journal of psychiatry. 2000 May 1;157(5):816-8.
- Gershon J, Gershon J. A meta-analytic review of gender differences in ADHD. Journal of attention disorders. 2002 Jan;5(3):143-54.
- Lord C, Charman T, Havdahl A, Carbone P, Anagnostou E, Boyd B, Carr T, De Vries PJ, Dissanayake C, Divan G, Freitag CM. The Lancet Commission on the future of care and clinical research in autism. The Lancet. 2022 Jan 15;399(10321):271-334.
- Gould J, Ashton-Smith J. Missed diagnosis or misdiagnosis? Girls and women on the Autism spectrum. Good Autism Practice (GAP). 2011 May 31;12(1):34-41.
- Aarons M, Gittens T. The handbook of autism: a guide for parents and professionals. Routledge; 2002 Jan 4.
- Mandy W, Chilvers R, Chowdhury U, Salter G, Seigal A, Skuse D. Sex differences in Autism spectrum disorder: evidence from a large sample of children and adolescents. Journal of Autism and Developmental Disorders. 2012 Jul;42:1304-13.
- Jensen CM, Steinhausen HC. Comorbid mental disorders in children and adolescents with attention-deficit/hyperactivity disorder in a large nationwide study. ADHD Attention Deficit and Hyperactivity Disorders. 2015 Mar;7:27-38.
- Zylowska L, Ackerman DL, Yang MH, Futrell JL, Horton NL, Hale TS, Pataki C, Smalley SL. Mindfulness meditation training in adults and adolescents with ADHD: A feasibility study. Journal of attention disorders. 2008 May;11(6):737-46.
